BACKGROUND: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes. METHODS: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events. CONCLUSION: The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality.

• MeSH
• Arterial Pressure * physiology   MeSH
• Adult MeSH
• Equivalence Trials as Topic MeSH
• Cardiopulmonary Resuscitation * methods   MeSH
• Coma etiology   MeSH
• Humans MeSH
• Multicenter Studies as Topic MeSH
• Randomized Controlled Trials as Topic MeSH
• Resuscitation * MeSH
• Heart Arrest * therapy   physiopathology   mortality   MeSH
• Treatment Outcome MeSH
• Out-of-Hospital Cardiac Arrest * therapy   physiopathology   mortality   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial Protocol MeSH

BACKGROUND: Fever is associated with brain injury after cardiac arrest. It is unknown whether fever management with a feedback-controlled device impacts patient-centered outcomes in cardiac arrest patients. This trial aims to investigate fever management with or without a temperature control device after out-of-hospital cardiac arrest. METHODS: The TEMP-CARE trial is part of the 2 × 2 × 2 factorial Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, a randomized, international, multicenter, parallel-group, investigator-initiated, superiority trial that will evaluate sedation strategies, temperature management, and blood pressure targets simultaneously in nontraumatic/nonhemorrhagic out-of-hospital cardiac arrest patients following hospital admission. For the temperature management component of the trial described in this protocol, patients will be randomly allocated to fever management with or without a feedback-controlled temperature control device. For those managed with a device, if temperature ≥37.8°C occurs within 72 h post-randomization the device will be started targeting a temperature of ≤37.5°C. Standard fever treatment, as recommended by local guidelines, including pharmacological agents, will be provided to participants in both groups. The two other components of the STEPCARE trial evaluate sedation and blood pressure strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. A physician blinded to the intervention will determine the neurological prognosis following European Resuscitation Council and European Society of Intensive Care Medicine guidelines. The primary outcome is all-cause mortality at six months post-randomization. To detect a 5.6% absolute risk reduction (90% power, alpha .05), 3500 participants will be enrolled. Secondary outcomes include poor functional outcome at six months, intensive care-related serious adverse events, and overall health status at six months. CONCLUSION: The TEMP-CARE trial will investigate if post-cardiac arrest management of fever with or without a temperature control device affects patient-important outcomes after cardiac arrest.

• MeSH
• Fever * therapy   MeSH
• Cardiopulmonary Resuscitation * MeSH
• Humans MeSH
• Multicenter Studies as Topic MeSH
• Randomized Controlled Trials as Topic MeSH
• Body Temperature MeSH
• Hypothermia, Induced * instrumentation   MeSH
• Out-of-Hospital Cardiac Arrest * therapy   complications   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial Protocol MeSH

Úvod: Badmintonová zranění jsou i přes celosvětovou oblibu tohoto sportu relativně opomíjenou problematikou. Metodika vyhledávání studií: Tento přehledový článek se zaměřuje na literaturu a výzkum zranění v badmintonu a na možnosti konzervativní léčby společně s rehabilitací těchto zranění. Jedním z cílů bylo shrnout poznatky z dostupných vědeckých studií publikovaných do roku 2023. Vyhledávání relevantní literatury bylo realizováno v databázích PubMed a Web of Science pomocí anglických ekvivalentů klíčových slov: badminton, zranění, etiologie, prevence, fyzioterapie. Výsledky: Celkem bylo pro tvorbu článku nalezeno a využito 51 studií, které se zabývají rizikovými faktory badmintonových zranění, jejich konkrétním typem a incidencí (zejména incidencí a rizikovými faktory), fyziologickými nároky badmintonu a možnostmi léčby daných poranění s důrazem na sportovní fyzioterapii. Studie zabývající se specificky možnostmi rehabilitace a jiných konzervativních postupů pro hráče badmintonu nebyly nalezeny. Možnosti rehabilitace vycházejí z aktuálních poznatků vztahující se obecně zejména k akutním a chronickým zraněním ve sportu. Diskuze: Ze současné evidence se jako efektivní přístup ke zraněním z přetížení jeví progresivní zatížení prvky silového tréninku s cílem navození pozitivních adaptačních změn v postižené tkáni. Ve sportovní fyzioterapii bývá hojně užíváno např. prvků kryoterapie, která ovšem pro podporu hojení a regenerace úponových bolestí nemá dostatečnou evidenci. Zranění, která vznikají akutním nedostatkem kapacity tkáně snášet nadměrnou zátěž, by měla být léčena primárně pohybovou terapií s konkrétně nastavenými parametry. Konkrétní rehabilitační postupy pozdní fáze návratu do hry jsou podmíněny specifikami sportu, jeho biomechanikou a konkrétním typem zranění. Závěr: I když je k většině zranění v badmintonu přistoupeno konzervativní metodou léčby, neexistuje dostatečná evidence vztahující se k rehabilitaci zranění specificky u badmintonistů. Cílem léčby badmintonových zranění je snížení bolestivosti, zvýšení kapacity, zlepšení koordinace a balance. Z východisek práce vyplývají následně i možnosti prevence zranění a konzervativních léčebných postupů zranění s akcentem na sportovní fyzioterapii.

Introduction: Badminton injuries are a relatively neglected issue despite the worldwide popularity of the sport. Methodology of the study search: This review article focuses on the literature and research on badminton injuries and conservative treatment options along with rehabilitation of these injuries. One of the objectives was to summarize the findings from available scientific studies published up until 2023. The search for relevant literature was performed in PubMed and Web of Science databases using the English equivalents of the keywords: badminton, injury, etiology, prevention, and physiotherapy. Results: A total of 51 studies were identified and used for the development of the article, which dealt with the risk factors of badminton injuries, their specific type and incidence (especially incidence and risk factors), the physiological demands of badminton, and treatment options for the injuries in question, with an emphasis on sports physiotherapy. Studies specifically addressing rehabilitation options and other conservative treatments for badminton players were not found. Rehabilitation options are based on current knowledge related to acute and chronic injuries in the sport in general. Discussion: From current evidence, progressive loading with elements of strength training to induce positive adaptive changes in the affected tissue appears to be an effective approach to overuse injuries. For example, elements of cryotherapy are widely used in sports physiotherapy, but there is insufficient evidence to support healing and regeneration of tendon pain. Injuries that result from an acute lack of tissue capacity to tolerate excessive load should be treated primarily with movement therapy with specific parameters. Specific rehabilitation procedures of the late phase of return to play are conditioned by the specifics of the sport, its biomechanics, and the particular type of injury. Conclusion: Although most injuries in badminton are treated conservatively, there is insufficient evidence relating to injury rehabilitation specifically for badminton players. The goal of treatment for badminton injuries is to reduce soreness, increase capacity, and improve coordination and balance. The premise of this article subsequently suggests options for injury prevention and conservative injury treatments with an emphasis on sports physiotherapy.

• MeSH
• Humans MeSH
• Racquet Sports MeSH
• Athletic Injuries * etiology   prevention & control   rehabilitation   MeSH
• Physical Therapy Modalities MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Publikace obsahuje tabulky, které se zaměřují na první kontakt zdravotní záchranné služby s pacientem, na terapii náhlých/urgentních příhod a na urgentní příjem pacientů. Určeno odborné veřejnosti.; Kapesní příručka Tabulky pro medicínu prvního kontaktu ve svém druhém, přepracovaném a rozšířeném vydání obsahuje více než 250 vybraných škál, schémat, skórovacích systémů, návodů a výpočtů uspořádaných podle medicínských oborů, konkrétně urgentní medicíny, interny, chirurgie a traumatologie, kardiologie, pneumologie a ORL, neurologie, pediatrie, psychiatrie, porodnictví, paliativní medicíny, zobrazovacích metod či ošetřovatelství. Je tak praktickým a pohodlným nástrojem k rychlému vyhledání referenčních hodnot, výpočtu různých parametrů, dávkování léčiv nebo antidot, vyhledání postupů v naléhavých situacích či kódů diagnóz a řady jiných potřebných informací, jež si, když nebývají používány zcela rutinně, nelze pamatovat. Z tohoto důvodu je příručka předkládána zejména pracovníkům záchranných a dalších pohotovostních služeb, praktickým lékařům a sestrám domácí péče, kteří ji ocení především jako pomůcku při práci v terénu, kde je okamžité využití jiných zdrojů informací nepraktické, obtížné či nemožné.

• MeSH
• Emergency Treatment MeSH
• Emergency Service, Hospital MeSH
• Emergency Medical Services MeSH
• Publication type
• Tables MeSH

• Conspectus
• Lékařské vědy. Lékařství
• NML Fields
• urgentní lékařství

Smrt mozku definujeme jako stav po katastrofálním poškození mozku s trvalou nevratnou ztrátou všech funkcí celého mozku, včetně kmene. Stanovení diagnózy je založeno na klinickém vyšetření, kdy je zcela nepřípustná falešná negativita jednotlivých testů, které podporují ireverzibilní postižení mozkového kmene od mesencefala (fotoreakce) přes pons Varoli (korneální, okulocefalický reflex a algické podráždění v obličeji) až po prodlouženou míchu (dávivý a kašlací reflex). V současné době není jasně stanovena metodika provedení jednotlivých vyšetření. Tento článek pojednává o základním klinickém vyšetření při stanovení smrti mozku a apnoickém testu. Součástí publikace je rovněž soubor videí, která ukazují pozitivní nález při stanovení smrti mozku (čili areflexii) a nález, který není kompatibilní se smrtí mozku (přítomnost normální odpovědi).

We define brain death as a condition following catastrophic brain injury with permanent irreversible loss of all functions of the entire brain, including the brain stem. Diagnosis is based on clinical examination, where are completely unacceptable false negative individual tests that support irreversible brainstem involvement from the mesencephalon (photoreaction) to the pons Varoli (corneal, oculocephalic reflex and facial alginic irritation) to the medulla oblongata (gag and cough reflex). At present, the methodology for performing each exa­mination is not clearly established. This article discusses the basic clinical examination in the determination of brain death and the apnea test. The publication also includes a set of videos that show a positive finding in the determination of brain death (absence of reflex) and a finding that is not compatible with brain death (presence of a normal response).

• Keywords
• apnoický test, funkce mozkového kmene, reflexy mozkového kmene,
• MeSH
• Diagnostic Techniques, Neurological MeSH
• Humans MeSH
• Brain Death * diagnosis   MeSH
• Brain Stem MeSH
• Neurologic Examination MeSH
• Reflex MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND: There are limited data on the causes of death in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to analyse the causes of death among patients who received ECPR following out-of-hospital cardiac arrest (OHCA). METHODS: In this post-hoc analysis of a prospective registry, the causes of death were categorized using a predefined method specifically developed for cardiac arrest patients. Two investigators independently assigned each patient to one of five predefined categories of death, with interrater reliability measured using Fleiss' kappa. RESULTS: From January 2012 to December 2023, a total of 1,219 OHCA patients were admitted to the hospital, of whom 210 underwent ECPR. Among these, 152 (72.3%) patients died during their index hospitalization. The median age of deceased patients was 57 years, with 80.9% being male, and the median time to ECPR initiation was 62 min (IQR: 53-72). Interrater agreement was 0.81. The most common primary cause of death was refractory shock (75/152 patients, 49.3%), followed by neurological injury (69/152 patients, 45.3%), rearrest (7/152 patients, 4.6%), and comorbidities (1/152 patients, 0.6%). CONCLUSIONS: Refractory shock was the leading cause of death among our cohort of ECPR patients, followed closely by neurological complications, while other causes were rare.

• MeSH
• Cardiopulmonary Resuscitation * methods   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation * mortality   methods   MeSH
• Cause of Death MeSH
• Prospective Studies MeSH
• Registries MeSH
• Aged MeSH
• Out-of-Hospital Cardiac Arrest * therapy   mortality   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Poranění míchy je spojeno nejen s poruchou citlivosti a hybnosti pod úrovní léze, ale také s dalšími komplikacemi, jako jsou dysfunkce autonomního nervového systému, spasticita nebo neuropatické bolesti. Zatímco u nekompletních míšních lézí se daří intenzivní rehabilitací zmírnit neurologický deficit, u klinicky kompletních lézí se neurologický obraz zásadně nemění. V posledních letech se zkoumá potenciál epidurální míšní stimulace, která se ukazuje jako slibná metoda schopná ztracené funkce i u kompletních míšních lézí částečně obnovit. V souborném referátu mapujeme rozvoj metody od ovlivnění bolesti až po obnovení volní hybnosti s využitím digitálního mostu mezi motorickou kůrou a míšním stimulátorem. Během posledních 20 let došlo k významnému posunu od mírného zlepšení hybnosti u nekompletních lézí až po obnovení stoje i chůze u motoricky kompletních poranění. Součástí práce je také souhrn ovlivnění autonomních funkcí s efektem na kardiovaskulární systém, vyprazdňování či sexuální funkce. Limitem uvedených studií je především heterogenita nastavení programů, malé soubory pacientů a také rizika spojená s implantací stimulátoru. I tak představuje epidurální míšní stimulace významný posun v léčbě míšního poranění s pozitivním vlivem na kvalitu života této populace.

Spinal cord injury is associated not only with sensory and motor impairment below the level of the lesion, but also with other complications such as autonomic nervous system dysfunction, spasticity, or neuropathic pain. While intensive rehabilitation can alleviate neurological deficits in incomplete spinal cord lesions, the neurological picture in clinically complete lesions remains fundamentally unchanged. In recent years, the potential of epidural spinal cord stimulation has been investigated, showing promise as a method capable of partially restoring lost function even in complete spinal cord lesions. This review outlines the development of the method, from pain modulation to the restoration of voluntary movement using a digital bridge between the motor cortex and spinal cord stimulator. Over the past twenty years, significant progress has been made from slight improvement in mobility in incomplete lesions to the restoration of standing and walking in motor complete injuries. The work also includes a summary of the effects on autonomic functions, with impacts on the cardiovascular system, bladder control, and sexual functions. The limitations of these studies are primarily the heterogeneity of program settings, small patient cohorts, and the risks associated with stimulator implantation. Nevertheless, epidural spinal cord stimulation represents a significant advance in the treatment of spinal cord injury, with a positive impact on the quality of life for this population.

• MeSH
• Autonomic Nervous System MeSH
• Electric Stimulation Therapy methods   MeSH
• Clinical Studies as Topic MeSH
• Humans MeSH
• Spinal Cord Stimulation * methods   MeSH
• Recovery of Function MeSH
• Paraplegia therapy   MeSH
• Spinal Cord Injuries * therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Oxidative stress and chronic inflammation are important drivers in the pathogenesis and progression of many chronic diseases, such as cancers of the breast, kidney, lung, and others, autoimmune diseases (rheumatoid arthritis), cardiovascular diseases (hypertension, atherosclerosis, arrhythmia), neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, Huntington's disease), mental disorders (depression, schizophrenia, bipolar disorder), gastrointestinal disorders (inflammatory bowel disease, colorectal cancer), and other disorders. With the increasing demand for less toxic and more tolerable therapies, flavonoids have the potential to effectively modulate the responsiveness to conventional therapy and radiotherapy. Flavonoids are polyphenolic compounds found in fruits, vegetables, grains, and plant-derived beverages. Six of the twelve structurally different flavonoid subgroups are of dietary significance and include anthocyanidins (e.g. pelargonidin, cyanidin), flavan-3-ols (e.g. epicatechin, epigallocatechin), flavonols (e.g. quercetin, kaempferol), flavones (e.g. luteolin, baicalein), flavanones (e.g. hesperetin, naringenin), and isoflavones (daidzein, genistein). The health benefits of flavonoids are related to their structural characteristics, such as the number and position of hydroxyl groups and the presence of C2C3 double bonds, which predetermine their ability to chelate metal ions, terminate ROS (e.g. hydroxyl radicals formed by the Fenton reaction), and interact with biological targets to trigger a biological response. Based on these structural characteristics, flavonoids can exert both antioxidant or prooxidant properties, modulate the activity of ROS-scavenging enzymes and the expression and activation of proinflammatory cytokines (e.g., interleukin-1beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)), induce apoptosis and autophagy, and target key signaling pathways, such as the nuclear factor erythroid 2-related factor 2 (Nrf2) and Bcl-2 family of proteins. This review aims to briefly discuss the mutually interconnected aspects of oxidative and inflammatory mechanisms, such as lipid peroxidation, protein oxidation, DNA damage, and the mechanism and resolution of inflammation. The major part of this article discusses the role of flavonoids in alleviating oxidative stress and inflammation, two common components of many human diseases. The results of epidemiological studies on flavonoids are also presented.

• MeSH
• Flavonoids * pharmacology   chemistry   therapeutic use   metabolism   MeSH
• Humans MeSH
• Neoplasms drug therapy   metabolism   pathology   MeSH
• Neurodegenerative Diseases drug therapy   metabolism   MeSH
• Oxidative Stress * drug effects   MeSH
• Inflammation * drug therapy   metabolism   pathology   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

DNA damage is a common event in cells, resulting from both internal and external factors. The maintenance of genomic integrity is vital for cellular function and physiological processes. The inadequate repair of DNA damage results in the genomic instability, which has been associated with the development and progression of various human diseases. Accumulation of DNA damage can lead to multiple diseases, such as neurodegenerative disorders, cancers, immune deficiencies, infertility, and ageing. This comprehensive review delves the impact of alterations in DNA damage response genes (DDR) and tries to elucidate how and to what extent the same traits modulate diverse major human diseases, such as cancer, neurodegenerative diseases, and immunological disorders. DDR is apparently the trait connecting important complex disorders in humans. However, the pathogenesis of the above disorders and diseases are different and lead to divergent consequences. It is important to discover the switch(es) that direct further the pathogenic process either to proliferative, or degenerative diseases. Our understanding of the influence of DNA damage on diverse human disorders may enable the development of the strategies to prevent, diagnose, and treat these diseases. In our article, we analysed publicly available GWAS summary statistics from the NHGRI-EBI GWAS Catalog and identified 12 009 single-nucleotide polymorphisms (SNPs) associated with cancer. Among these, 119 SNPs were found in DDR pathways, exhibiting significant P-values. Additionally, we identified 44 SNPs linked to various cancer types and neurodegenerative diseases (NDDs), including four located in DDR-related genes: ATM, CUX2, and WNT3. Furthermore, 402 SNPs were associated with both cancer and immunological disorders, with two found in the DDR gene RAD51B. This highlights the versatility of the DDR pathway in multifactorial diseases. However, the specific mechanisms that regulate DDR to initiate distinct pathogenic processes remain to be elucidated.

• MeSH
• Genome-Wide Association Study MeSH
• Genetic Predisposition to Disease MeSH
• Polymorphism, Single Nucleotide MeSH
• Humans MeSH
• Neoplasms * genetics   MeSH
• Immune System Diseases * genetics   MeSH
• Genomic Instability genetics   MeSH
• Neurodegenerative Diseases * genetics   MeSH
• DNA Repair * genetics   MeSH
• DNA Damage * genetics   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND: Acute Stanford type A aortic dissection is a severe emergency condition that, if left untreated, is associated with a high mortality rate. The extent of surgical repair may impact the outcomes of these patients. METHOD: Patients operated for acute type A aortic dissection from a multicentre European registry were included. Patients were categorized based on the following types of surgical intervention: isolated ascending aortic replacement, ascending aortic replacement with concomitant aortic valve replacement, aortic root replacement, partial or total arch replacement, and partial or total arch replacement with concomitant aortic root replacement. The primary outcome was mortality rate, both in-hospital and at 10 years. Secondary outcomes were acute kidney injury requiring dialysis, neurological complications, a composite endpoint including in-hospital death, neurological complications and/or dialysis, and proximal endovascular or surgical aortic re-operations at 10 years. RESULTS: 3702 patients were included. The adjusted risk of in-hospital mortality was higher in all subsets of patients compared to those who underwent isolated ascending aortic replacement. The adjusted rates of in-hospital mortality ranged from 16.4% (95% c.i. 15.3 to 17.4) among patients who underwent isolated ascending aortic replacement to 27.7% (95% c.i. 23.3 to 31.2) among those who underwent aortic arch and concomitant aortic root replacement. The adjusted risks of neurological complications, renal replacement therapy and of the composite endpoint were significantly higher in patients who underwent partial/total aortic arch replacement. The adjusted risk estimates of 10-year mortality rate were markedly higher in patients who underwent partial/total aortic arch replacement with or without concomitant aortic root replacement. Extensive aortic repair did not significantly reduce the risk of distal or proximal aortic reoperations. CONCLUSION: These findings suggest that, when feasible, limiting the extent of aortic replacement for acute type A aortic dissection may be beneficial in reducing mortality rate and major complications both in the short and long term. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04831073.

• MeSH
• Aortic Aneurysm surgery   mortality   MeSH
• Blood Vessel Prosthesis Implantation * adverse effects   mortality   methods   MeSH
• Aortic Dissection * surgery   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospital Mortality * MeSH
• Postoperative Complications * epidemiology   mortality   etiology   MeSH
• Registries * MeSH
• Reoperation statistics & numerical data   MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH